Continuum consults Flashcards
causes of abulia?
thalamic or orbitofrontal infarcts
causes of agitation
PCA and nondominant parietal infarcts
what is marchiafava bignami?
demyelination of corpus callosum due to nutritional deficiency in chronic alcoholics
what AED shouldnt be used with VPA?
topiramate: causes encephalopathy
what shouldn’t you use antipsychotics in?
Lewy body dementia
what is the syndrome and treatment? spells of choreiform or dystonic movements for seconds-minutes during movement or with startle?
paroxysmal kinesigenic choreoathetosis: a paroxysmal dyskinesia.
Kernig test
meningitis with resistance to passive extension at knee when lying on back
brudzinski test
meningitis with neck flexion there is flexion of hips/knees
meningitis to give steroids in?
pneumococcal
What causes waterhouse friderichsen disease?
N. meningo, with hemorrhage / adrenal failure
bugs (2) causing basilar meningitis
Cryptococcus, TB
Guess the bug: meningo encephalitis with tremor, diarrhea, rash, flaccid weak limb or parkinsonian.
MRI findings? What is the dx lab test?
WNV, look for CSF IgM Abs, MRI hsows hyperintense thalami, BG, SN
EEG findings in HSV encephalitis?
periodic sharp/slow wave complexes at 1-3 sec intervals between 2-15 days
What test confirms EBV as cause of encephalitis?
Both CSF PCR AND EBV nuclear Ag negative AND EBV capsid antigen positive (positive EBNA only can be nonspecific)
worst endocarditis risk factor
prosthetic mitral valve
Risk of stroke if EF < 40%
18%!, each decr 5% EF increases 5yr stroke risk by 8%
what causes atrophy of type II fibers, fast twitch glycolytic muscles but with normal labs?
steroid myopathy
Dx for this EMG: / NCS: slow NC velocity, prolonged or absent F waves, conduction block?
GBS
What might you see in axonal type GBS on EMG/NCS?
spared sensory but low/absent CMAPs and early denervation
Mechanism in Botulism
Presynaptic toxin NM blockade preventing ACh release
EMG findings in botulism?
Decr CMAP, incremental response to tetanic stim
mechanism of ciguatera neurotoxin action?
ingestion of na-channel blocker ingestion, causing acute demyelinating neuropathy
two problems to think of when you get symmetric weakness no sensory, no demyelination?
- Tick paralysis: NMJ problem or distal axon
2. AIP (porphyria), spares CNs, lots of autonomic issues
if a MG patient has poor response to acetylcholinesterase inhibitors, think of what?
anti-MUSK
best EMG test for MG?
single fiber EMG
what is the path and EMG finding in critical illness myopathy
path is loss of thick filaments
EMG is low amp CMAPs, preserved SNAPs, no decrement, small polyphasic MUPs
fibrillations and positive sharp waves are seen in what?
polyneuropathy
Where do you see shrinking lung syndrome?
neuropathy and diaphragmatic weakness in SLE
Treatment of periodic kinesthogenic choreoathetosis.
Treat with Carbamazepime (Na-channel blocker)
